Provider Demographics
NPI:1699518811
Name:O'CONNOR, BOBBIE JEAN (LMHC)
Entity type:Individual
Prefix:
First Name:BOBBIE
Middle Name:JEAN
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 RIVERPLACE BLVD APT 2106
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-1818
Mailing Address - Country:US
Mailing Address - Phone:904-923-6468
Mailing Address - Fax:
Practice Address - Street 1:1401 RIVERPLACE BLVD APT 2106
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-1818
Practice Address - Country:US
Practice Address - Phone:904-923-6468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-15
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3638101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty